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Determining the Intra-observer Reliability of the Evaluation of Cranial Strain Patterns

Journal: The Journal of the American Osteopathic Association Date: 2006/08, 106(8):Pages: 471. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2006.106.8.471/html)

Keywords:

cranial rhythmic impulse [26]
cranial strain [6]
cranium [51]
intra-observer reliability [2]
observational study [152]
palpation [190]

Abstract:

Purpose: To perform a prospective, randomized, single blinded, observational study to determine the intra-observer reliability of common palpatory tests used to diagnose strain patterns of the cranium. Methods: Two board certified Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine (NMM/OMM) specialists examined 24 subjects each subdivided into three diagnostic groups of eight subjects: those with a history of headaches, with asthma, or with neither (healthy control group). Examiners diagnosed each subject's cranial rhythmic impulse (CRI) rate, cranial strain pattern (CSP), and quadrants of restriction (QOR). To blind the examiners, the subjects were divided into subgroups based on hair length and style. Examiners evaluated four subjects at a time with each subject being evaluated three times per session in a random order. Kappa coefficients (κ) were used to measure intra-observer reliability. Results: Overall, the cranial strain pattern diagnosis showed the highest reliability (κ=0.67). Within individual diagnostic groups, the cranial strain pattern diagnosis showed the highest reliability for the healthy group (κ=0.82), followed by headache (κ=0.67) and asthma (κ=0.52) groups. CRI rate showed only fair reliability (κ=0.23). CRI rate by diagnostic groups, asthma had the lowest reliability (κ=0.10), while headache and healthy groups had fair reliability (κ=0.23 and 0.29 respectively). The three of the four quadrants of restriction (QOR) showed moderate overall reliability (κ=0.44-0.52), while the left posterior quadrant had only fair reliability (κ=0.33). In both the headache and healthy groups, the left anterior quadrant showed substantial reliability (κ=0.60 and 0.61 respectively) while the left posterior quadrants showed fair reliability in all three groups. Comment: There are no previous studies on the intra-observer reliability of CSP. These results indicate good intra-observer reliability can be obtained when evaluating cranial strain patterns. Yet the intra-observer reliability for CRI and QOR were found to be only fair. This finding for intra-observer reliability for CRI was consistent with previous studies. Now that intra-observer reliability has been documented, studies need to be done to establish the inter-observer reliability for QOR, CRI and CSP.


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